Healthcare Utilization in Patients With Chronic Rhinosinusitis With Nasal Polyps – Analysis of the Reg-ent Clinical Data Registry

Abstract

Background Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) who fail medical management are often offered endoscopic sinus surgery (ESS). Dupilumab is also used to treat patients with inadequately controlled CRSwNP. Objective This retrospective cohort study uses a national registry to examine the patterns in healthcare utilization in patients with CRSwNP. Methods A review of the AAO-HNSF Reg-ent SM data registry of CRSwNP patients who underwent ESS or received dupilumab from 2019 to 2025 was performed. The primary outcome of oral antibiotic and corticosteroid free-probability was summarized by Kaplan-Meier estimates and compared between dupilumab treatment and surgery by piecewise Cox proportional hazards model with follow-up time split at 6 months while adjusting for age, sex, ethnicity, race, history of asthma, and allergic rhinitis. Secondary outcomes include polyp recurrence/persistence and repeat imaging. Results 12,944 patients were included. Kaplan-Meier analysis demonstrated the hazard ratio changing over time indicating lower relative hazard of post-intervention antibiotics/corticosteroid use early on among patients who were treated with dupilumab, but the relative hazard of the group increased over time. Antibiotic/corticosteroid use was lower among dupilumab treated patients compared to ESS patients (HR = 0.873; aHR = 0.740; p < 0.0001) in the first 6 months, but they demonstrated higher antibiotic/corticosteroid use thereafter (HR = 1.60, aHR = 1.279; p < 0.0012). There was an increased risk of nasal polyp recurrence/persistence in the dupilumab group during both time periods (aHR = 1.189 & 2.040 before and after 6 months, p < 0.0005 & 0.0001). During the first 6 months, the hazard of repeat imaging was higher among dupilumab patients compared to ESS patients (aHR = 2.098; p < 0.0001). After 6 months, the hazard among dupilumab patients was lower than the ESS patients (aHR = 0.409, p < 0.0001). Conclusion CRSwNP patients treated with dupilumab and ESS demonstrated variable healthcare utilization over time, highlighting the importance of patient selection and shared decision making when considering initiation of dupilumab therapy for CRSwNP.